Intracranial Hemorrhage Diagnosed with Transcranial Ultrasound in a Comatose, Postliver Transplant Patient.

Transcranial ultrasound is a well validated diagnostic technique used to assess cerebral perfusion or to detect structural damage in intensive care unit patients. We report a case of an intracranial hemorrhage first suspected during a trans-cranial Doppler assessment of a postorthotopic liver transplant patient. The patient was at considerable risk of bleeding, due to a primary graft nonfunction, but he had also elevated ammonium levels, justifying the comatose state, and no focal neurological deficits. The clinical conditions were unstable, making the transportation to the radiology suite at elevated risk. The hemorrhage was identified by B-mode ultrasound before the development of focal neurological signs or alterations in the middle cerebral artery Doppler flow and optical nerve sheath diameter. We suggest that transcranial B-mode ultrasound may prove useful as a monitoring tool in selected patients, also providing early clinical suspicion for the onset of intracranial hemorrhage even before the development of intracranial hypertension or focal neurological deficits.